Preparation and Implementation of STAG Recommendations

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Preparation and Implementation of STAG
Recommendations
MEETING OF MANAGERS OF THE NTP IN THE EMR RABAT,
MOROCCO 17-19 JUNE 2003

• Recent Estimations in EMR Countries
• Dr. John Jabbour
• Surveillance Officer, STB

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Recommended Regional Activities

• Validity of the estimates
• Commence a process to re-examine the estimates
• Countries thought to be excessive
• By December 2002
• Expected Outcome
• Report on the results of the revised estimates.

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Activities Taken

• Damascus Exercise on TB Surveillance
• Cairo Workshop on TB Epidemiology and Surveillance

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Damascus Exercise

• WHO, HQ and EMRO Activity
• Took place in Damascus Syria, February 15-21.
• Countries participated
• Iran, Jordan, Egypt, Lebanon and Syria

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Objectives

• Investigate the possible causes of low case
  detection rates in the countries.
• Re-estimate the TB burden using the results of
  the analytical exercise.
• Produce an improved package of analytical
  techniques for TB control programmes.
• Upgrade the analytical skills of the NTP
  statistical staff.

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Additional Objectives

• Revise the different types of the TB
  epidemiologic indicators
• Diagnosis, DOTS Coverage, Treatment, Death and
  drug consumption.
• Prepare for the TB Epidemiology and Surveillance
  workshop that took place in Cairo from 3-5 March
  2003.

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TB Workshop on Epidemiology and Surveillance

• HQ, EMRO Activity
• Took place in Cairo, March 3-6.
• Countries participated are
• Egypt, Iran, Jordan, Lebanon, Oman, Saudi Arabia,
  Sudan, Syria, Tunisia and Yemen.

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TB Workshop on Epidemiology and Surveillance

• The burden of TB by country
• The progress towards the WHO targets of 70 case
  detection and 85 cure.
• Methods to assess TB morbidity and mortality, and
  how these methods can be applied to national
  populations and to sub-populations.
• Methods to assess case detection and cure rates,
  and methods of analysing data to explain the
  results.

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Day 1 data review by country

• Summary of available data describing TB burden
  and trends
• Summary of estimates of case detection rates,
  nationally and for sub-populations of special
  interest (e.g. by region, ethnic group, age, sex)
  
• Summary of treatment outcomes, nationally and for
  specific sub-populations
• Summary of impact of TB control (incidence,
  prevalence, deaths)
• Overview of outstanding analytical problems (from
  perspective of the NTP)

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Day 2 surveys and estimates

• AM Surveys of TB infection and disease
• PM Methods for making estimates of TB incidence
  (prevalence, deaths)

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Day 3 analyses of surveillance data

• AM Examples from EMR and elsewhere, based on
  standard and other indicators
• PM Presentations of results by country

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Five indirect measures of TB incidence
5. Drug Consumption
Incidence, prevalence, deaths derived by
rearranging 4 equations
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• Proportion detected guess from quality of
  surveillance system e.g. USA probably detects
  about 95 of cases
• More objective e.g. health units reporting in
  any year
• Method 1 weak with poor surveillance, but strong
  MS is the ultimate goal

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• Disease prevalence from population surveys e.g.
  Philippines, China, Cambodia
• Duration time span of the condition measured in
  prevalence survey e.g. ss disease
• Duration from e.g. patients and physicians asked
  about reporting and treatment delays (often
  underestimated)

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• Styblo ratio 1 ARI to 50 ss/100,000 population
• Accuracy of ARI from tuberculin surveys?
• 150 breaks down when TB incidence not stable
  (gets bigger in decline), and in presence of HIV

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• Accuracy of deaths from vital registration?
• Case fatality more accurately measured from
  observed cohorts (but fate of defaulters,
  transfers?)
• CFR less accurately from unseen patients, whether
  treated or untreated

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Methods used by Country
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Revised Estimates